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Home My WebLink AboutSLO Citizens for Measure G - Form 410 - Initial - 07-21-14Statement of Organization Recipient Committee Statement Type ® Initial I. NAME OF COMMITTEE Not yet quakfied ❑ or 07 (,02014 Date qualified as committee SLO CITIZENS FOR MEASURE G STREET ADDRESS (NO P.O. BOX) ❑ Amendment List I.D. number: a I -1 Date qualified as committee (H applicable) ❑ Termination —See Part 5 List I.D. number: a Date of Termination CITY STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 ( MAILING ADDRESS (IF DIFFERENT) PO BOX 15728, SAN LUIS OBISPO, CA 93406 FAX / E-MAIL ADDRESS COUNTY OF DOMICILE ]ORISDIC"ON WHERE COMMITTEE i5 ACTIVE SAN LUIS OBISPO SAN LUIS OBISPO Attach additional information on appropriately labeled continuation sheets. Date Stamp For Official Use Only V';— JUU 2 5 2014 Treasurer and Other Principal Officers NAME OF TREASURER HILLARY TROUT y STREET ADDRESS (NO P.O BOX) 1175 BUCHON STREET CITY SAN LUIS STATE CA ZIP CODE 93401 AREA CODE /PHONE (805)541 -0839 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOXI CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) SEE CONTINUATION SHEET STREET ADDRESS (NO P.O BOX) CITY STATE ZIP CODE AREA CODE /PHONE 3, Veri 'caca_ o n i have used-' sed alk reasonahke diligence in preparing this statement and to the hest of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the fare sing ` true and correct. Executed on 07/21/2014 By DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLUNG OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization CALIFORNIA ' Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER SLO CITIZENS FOR MEASURE G - All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION COAST NATIONAL BANK ADDRESS AREACODE /PHONE (805)541 -0400 CITY 101023818 STATE ZIP CODE 500 MARSH STREET SAN LUIS OBISPO CA 93401 4. Type of Committee Complete the applicable sections. - List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. - List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." - If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CAN ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATES) NAME OR MEASUREW FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIOATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE BALLOT MEASURE G -14 CITY OF SAN LUIS OBISPO SUPPORT ❑✓ OPPOSE ❑ suPpOpT DM FPPC Form 410 (Dec /2012) FPPC Advice: advice@fppc.m.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE SLO CITIZENS FOR MEASURE G PROVIDE BRIEF DESCRIPTION OF ACTIVITY NAME Of SPONSOR (Continued) Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑CITYCommittee ❑ COUNTY Committee ❑ STATE Committee List additional sponsors on an attachment. NO. AND CITY GROUPOR STATE SIP COM Page 3 ❑ /f Date qua hfi¢d 5. Termination Requirements By signing the verification, the treasurer, assistanttreasarerand/or ca ndidate, officeh older, or p ropone nt certify that a I I of th e following condin ons have been met: • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. — Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov CALIFORNIA FORM 410 CONTINUATION SHEET NAMES OF PRINCIPAL OFFICERS PRINCIPAL OFFICER: PIERRE RADEMAKER STREET ADDRESS: 1041 CHORRO STREET #230 CITY: SAN LUIS OBISPO STATE: CA ZIP CODE: 93401 AREA CODE /PHONE: (805) 544 -7774 PRINCIPAL OFFICER: STREET ADDRESS: CITY: STATE: ZIP CODE: AREA CODE /PHONE: CLINT PEARCE 284 HIGUERA STREET SAN LUIS OBISPO CA 93401 (805) 748 -9097 PRINCIPAL OFFICER: ANDREA PEASE STREET ADDRESS: 2410 LEONA AVENUE CITY: SAN LUIS OBISPO STATE: CA ZIP CODE: 93401 AREA CODE /PHONE: (805) 235 -6355 END OF CONTINUATION SHEET Mejia, Anthony From: Hillary Trout < Hillary@brokenearthwinery.com> Sent: Thursday, July 24, 2014 3:17 PM To: Mejia, Anthony Subject: CA Form 410 Attachments: CA Form 410 Stmt of Org Recipient Committee.pdf Anthony, It was great to finally meet you this morning. A lot going on with getting the campaign started! We got a notice back from SOS that the name was already in use so we filed a new 410 with a new name. Please see attached copy of filing made with the Secretary of State. Thank you, Hillary Trout (805) 709 -5194 \� /Statement of Organization Recipient Committee Statement Type ® Initial ❑I Amendment ❑ Termination — See Part 5 Not yet qualified ❑ or List I D number List I D number a 07 09 2014 , a Date qualified as committee Date qualified as committee Date of Termination Ili appllcable) NAME OF COMM I I'TEE I SLO CITIZENS FOR MEASURE G t STREET ADDRESS (NO PO 00x) i 1041 CHORRO STREET #230 CITY STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 (805)544 -7774 MAILING ADDRESS (IF OIFFEREN i) I Dn Rnx 11r,70A cent t t 11Q c nalcDn rA WlAnr, FAX / E MAIL ADDRESS 805 - 544 -7774 / INFO @CITIZENSFORG COM COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE SAN LUIS OBISPO SAN LUIS OBISPO i Attach additional information on appropriately labeled continuation sheets I have used all reasonable diligence In preparing this statement and to penalty of perjury under the laws of the State of California that the fo1 Executed on 07/21/2014 By , DATE I Executed on By I) DATE I SIGNATU Executed on By I(I DATE to Date Stamp JUL 2 8 2014 DEBRA BOt For Official Use Only �^ AUG 112 201 NAME OF TREASURER I HILLARY TROUT STRIKE I ADDRESS (NO PO BOX) 1175 BUCHON STREET CITY ) STATE ZIP CODE AREA CODE /PHONE SAN LUIS OBISPO CA 93401 (805)541 -0839 NAME OF ASSISTANT TREASURER, IF ANY STRLET ADDRESS IND PO CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICERS) SEE CONTINUATION SHEET STREET ADDRESS (NO PO BOX) CITY STATE ZIPCODE AREA CODE /PHONE Df my knowledge the Information contained herein Is true and complete I certify u true and correct ATURE Of TREASURER OR ASSISTANT TREASURER I LL ING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGN AT Unt Ut LUN I nULLINU UH ILLIIULUtn, LANUIUAI t, UK D IAI It MtAaunc vnu FURL I Executed on By I+I DATE 1 VMNATIINF119 r-nNTRnI 11Nr. nFFlrrltnlnrn rANnInATP nN<TGTf Mrfi IoRF PAnPnNCN FPPC Form 410(Dec /2012) FPPC Advice. advice @fppc w gov (866/275 -3772) www.fppc.ca gov I/ l -� Statement of Organization CALIFORNIA 1 Recipient Committee FORM INSTRUCTIONS ON REVERSE 1 Page 2 COMMITTEE NAME IID NUMBER SLO CITIZENS FOR MEASURE G • All committees must list the financial Institution where the campaign bank account Is located NAME OF FINANCIAL INSTITUTION COAST NATIONAL BANK ADDRESS AREACODE /PHONE I BANK ACCOUNT NUMBER (805)541 -0400 1101 CITY STATE 18 ZIP CODE MARSH SAN LUIS OBISPO CA 93401 � • ` • F F F F F K u1'.• . a��L�M1: N�S. npitlF. 9' i�' aii�• MA�{ v: rA- �11��a� .5.1��:L"- 'kK'wv.�#:!�'�iw t��,F.'�rcm' Fi ?1�: �`iS C��,��;'r�T.P�.K�1.. I • List the name of each controlling officeholder, candidate, or state measure proponent If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election • List the political party with which each officeholdeir or candidate is affiliated or check "nonpartisan " • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee 1 NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY • Primarily formed to support or oppose specific candidates or measures In a single election List below CANDIDATE($) NAME OR MEASURE(S) FULL TITLE (INCLUDE I ALLOT NO OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION I (INCLUDE DISTRICT NO , CITY OR COUNTY, AS APPLICABLE) CHECK ONE ' BALLOT MEASURE G -14 CITY OF SAN LUIS OBISPO SUPPORT ✓0 OPPOSE I El suPPOgT OPPOSE FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca gov (866/275 -3772) www fppc ca gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE SLO CITIZENS FOR MEASURE G Not formed to support or oppose specific candidates or measures in a single election Check only one box ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY Page 3 List additional sponsors on an attachment NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR i STREET ADDRESS NO AND STREET CITY STATE ZIP CODE Date qua hoed f pae.>nnviy +.> fA ^�45FYiM'YY V•yµRq' ^°1R[•�A 1SV l)li VRtlVfP rCasurer,NrY'•YIWYM•'ti �f iV° o ^e fePI111+YWV'1M Il3t'» + >I•tint¢r•!gP�v'Te7co'fi ng'e oondition's(R ee'N2 F STer, "rninationRegulrement "s • 'f ay slgningdhe,venficatTOn?Pthe treasu "rei;�asslstanLireasurerand /Dr candidate!, o`fficeholdeuror proponent cernfy�that all ot�thefollowmg condmonshave`�been met: • This committee has ceased to receive contributions and make expenditures, • This committee does not anticipate receiving c' ntrlbutTons or making expenditures in the future, • This committee has eliminated or has no Intention or ability to discharge all debts, loans received, and other obligations, • This committee has no surplus funds, and j • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates Refer to Government Code Section 89519 1 -- Leftover funds of ballot measure committees maybe used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 185215 FPPC Form 410(Dec /2012) FPPC Advice advice @fppc.ca.gov (866/275 -3772) www fppc.ca.gov